Living in a tight-knit neighborhood was associated with a lower rate of stroke among adults older than 50, researchers found.

Action Points

Living in a tight-knit neighborhood was associated with a lower rate of stroke among adults older than 50.

Point out that the relationship remained significant after adjustment for several health and psychosocial factors that have been associated with stroke risk.

Living in a tight-knit neighborhood was associated with a lower rate of stroke among adults older than 50, researchers found.

Each standard deviation increase in a measure of perceived neighborhood social cohesion was associated with a 15% lower likelihood of having a fatal or nonfatal stroke during follow-up (OR 0.85, 95% CI 0.75-0.97), according to Eric Kim, MS, a doctoral student at the University of Michigan in Ann Arbor, and colleagues.

The relationship remained significant after adjustment for several health and psychosocial factors that have been associated with stroke risk, they reported online in Social Science & Medicine.

"Stroke is a leading cause of disability in the United States and responsible for an estimated $25.2 billion in direct costs," they wrote. "Therefore, researchers are searching for novel predictors that imply targets for intervention."

"If future work consistently shows that neighborhood-level constructs provide a protective effect against stroke," they continued, "this line of research may further justify policy changes and neighborhood-level public health approaches to stroke prevention."

Numerous studies have examined the relationship between negative neighborhood factors -- including violence, noise, traffic, cleanliness, and air quality -- and poor health outcomes, but not many have explored the associations between positive neighborhood characteristics and health.

In three Chicago neighborhoods, a previous study showed that an increase in perceived social cohesion within the neighborhood -- a measure of "connectedness between and among neighbors and their willingness to intervene for the common good" -- was associated with a reduced risk of fatal stroke.

The study by Kim and colleagues built on that research by using data from a nationally representative cohort -- the prospective Health and Retirement Study -- and by including individual-level assessments of the perception of neighborhood cohesion.

The current analysis included 6,740 adults older than 50 (mean age 69) who were stroke-free at baseline.

At baseline, the participants reported their perceived neighborhood social cohesion by rating their agreement to the following four statements on a 7-point scale:

"I really feel part of this area."

"Most people in this area can be trusted."

"If you were in trouble, there are lots of people in this area who would help you."

"Most people in this area are friendly."

Through 4 years of follow-up, 3.9% of the participants had a stroke.

Higher perceived neighborhood social cohesion was associated with a 15% lower likelihood of stroke after adjustment for age, sex, chronic illness, marital status, education, and total wealth.

There were reductions of similar magnitude seen in models further adjusting for health behaviors and both negative and positive psychosocial factors, although the relationship fell just shy of statistical significance in the model that accounted for negative psychosocial factors, including anxiety, cynical hostility, depression, and negative affect (OR 0.86, 95% CI 0.75-1.00).

"This implies that perceived neighborhood social cohesion nearly displays a protective effect against stroke above and beyond the effects of the negative psychosocial states and traits tested," the authors wrote.

"Future research should ... examine personal and environmental factors that influence an individual's perception of neighborhood social cohesion and the potential pathways by which perceived neighborhood social cohesion may protect against stroke," they wrote.

The study was limited by the inability to explore the relationships in different ethnic minority groups and by the lack of information about certain factors that could have influenced the findings, including family history of cardiovascular or cerebrovascular disease and genetic vulnerability.

Support for publication of the study was provided by the Robert Wood Johnson Foundation's Pioneer Portfolio, which supports innovative ideas that may lead to breakthroughs in the future of health and healthcare. The Pioneer Portfolio funding was administered through a Positive Health grant to the Positive Psychology Center of the University of Pennsylvania.

The authors did not report any conflicts of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.